NYC04FA139

NTSB accident investigation · Beech 200 · Rupert, WV · June 13, 2004

Accident · FatalField investigationFinal report
Date
June 13, 2004, 08:30 local (12:30 UTC)
Place
Rupert, WV
Injuries
2 fatal
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N200BEBeech 200
Weather
Visual (VMC) · Day
Status
Completed · report March 30, 2005
Report
Approved by Office Director
Parties
Pratt & Whitney Canada, Raytheon Aircraft Company, FAA FSDO-09
FAA report
20040613020909A
Case key
59427

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The pilot-in-command's improper decision to continue VFR flight into IMC conditions, which resulted in controlled flight into terrain. Factors were the FAA Principle Operations Inspector's inadequate surveillance of the operator, and a low ceiling.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

In flight collision with terrain/waterCruise
Inadequate surveillance of operationFaa(organization)Factor
Improper decisionPilot in commandCause
Terrain condition - mountainous/hilly
Vfr flight into imc - continuedPilot in commandCause
Weather condition - low ceilingFactor

Analysis

An IFR flight plan and slot reservation were filed for the planned flight over mountainous terrain. The flightcrew intended to reposition to an airport about 30 miles southeast of the departure airport, pick up passengers, and then complete a revenue flight to another airport. The airplane departed VFR, and the flightcrew never activated the flight plan. A debris path was located, consistent with straight and level flight, near the peak of a mountain at 3,475 feet msl. Examination of the wreckage did not reveal any pre-impact mechanical malfunctions. Instrument meteorological conditions prevailed near the accident site, about the time of the accident. Further investigation revealed the aircraft operator was involved in two prior weather related accidents, both of which resulted in fatalities. A third accident went unreported, and the weather at the time of that accident was unknown. Over a period of 14 years, the same FAA principal operations inspector was assigned to the operator during all four accidents; however, no actions were ever initiated as a result of any of the accidents.

Factual narrative

History of flight

On June 13, 2004, about 0830 eastern daylight time, a Beech 200 (King Air), N200BE, was destroyed when it impacted Big Mountain, near Rupert, West Virginia. The certificated airline transport pilot and certificated commercial pilot were fatally injured. Instrument meteorological conditions prevailed near the accident site, for the flight that departed Summersville Airport (SXL), Summersville, West Virginia, about 0815; destined for Greenbrier Valley Airport (LWB), Lewisburg, West Virginia. An instrument flight rules (IFR) flight plan was filed for the repositioning flight conducted under 14 CFR Part 91.

According to a Federal Aviation Administration (FAA) inspector, who was also the operator's principle operations inspector (POI), the flightcrew intended to meet passengers at LWB, and take them to Charlotte, North Carolina. The POI reported that the pilot-in-command usually used data user access terminal (DUAT) to obtain weather information and file flight plans. The POI further stated that an IFR slot reservation and an IFR flight plan were on file for the first leg of the trip, to LWB. However, the flight plan was never activated.

The POI also reported that no radar data was recorded for the accident flight.

The wreckage was located on June 13, about 1400, near the peak of Big Mountain. The accident site was approximately 15 miles southeast of SXL, which was about mid-way between SXL and LWB.

The accident occurred during the hours of daylight; located about 37 degrees, 58.71 minutes north latitude, and 80 degrees, 41.56 minutes west longitude.

Personnel information

The pilot-in-command held an airline transport pilot certificate, with ratings for airplane single engine land and airplane multi-engine land. He also held a commercial pilot certificate, with a rating for airplane single engine sea; and a private pilot certificate, with a rating for glider aero tow. The pilot-in-command held a flight instructor certificate, with ratings for airplane single engine land and instrument airplane.

The pilot-in-command's most recent FAA first class medical certificate was issued on February 24, 2004.

According to the aircraft operator, the pilot-in-command had accumulated a total flight experience of 10,400 hours; of which, 1,500 hours were in the same make and model as the accident airplane, and 2,700 hours were in actual instrument conditions. During the 90 days preceding the accident, the pilot-in-command flew 80 hours; of which, 25 hours were in the same make and model as the accident airplane.

The copilot held a commercial pilot certificate, with ratings for airplane single engine land, airplane mutli-engine land, and instrument airplane. He also held a flight instructor certificate, with a rating for airplane single engine land.

The copilot's most recent FAA second class medical certificate was issued on December 29, 2003.

According to the aircraft operator, the copilot had accumulated a total flight experience of 2,910 hours; of which, 400 hours were in the same make and model as the accident airplane, and 175 hours were in actual instrument conditions.

Aircraft information

According to the aircraft logbooks, the airplane was maintained under an alternate approved inspection program (AAIP). On June 9, 2004, a "Phase 2" inspection was completed on the airplane. At that time, the airplane had accumulated approximately 9,444 hours of operation. According to the operator, the airplane had accumulated about 5 additional hours of operation from the time of the inspection, until the accident.

At the time of the inspection, the both engines had accumulated about 6,467 hours since overhaul.

Meteoroligical information

Lewisburg was located about 16 nautical miles southeast of the accident site, at a field elevation of 2,302 feet msl. The reported weather at LWB, at 0822, was: wind 190 degrees at 6 knots; visibility 7 miles; scattered clouds at 1,300 feet; ceiling 2,000 feet overcast; temperature 61 degrees F; dew point 61 degrees F; altimeter 30.23 inches Hg.

The reported weather at LWB, at 0838, was: wind calm; visibility 7 miles; ceiling 1,800 feet overcast; temperature 61 degrees F; dew point 61 degrees F; altimeter 30.23 inches Hg.

Raleigh County Memorial Airport (BKW), Beckley, West Virginia, was located about 26 nautical miles southwest of the accident site, at field elevation of 2,504 feet msl. The reported weather at BKW, at 0800, was: wind 160 degrees at 8 knots; visibility 7 miles; light rain; ceiling 800 feet broken; temperature 63 degrees F; dew point 61 degrees F; altimeter 30.20 inches Hg.

The reported weather at BKW, at 0822, was: wind 150 degrees at 9 knots; visibility 5 miles; light rain and mist; few clouds at 800 feet; ceiling 5000 feet broken; ceiling 7000 feet overcast; temperature 63 degrees F; dew point 61 degrees F; altimeter 30.20 inches Hg.

Wreckage and impact information

The investigative team arrived at the accident scene on June 14. The wreckage was resting on an approximate heading of 140 degrees, about 3,475 feet msl. A majority of the wreckage had been consumed by a post-crash fire, and a strong fuel odor was present at the scene. A debris path was observed, originating at a tree-strike, and extended on an approximate 140-degree heading, about 500 feet, terminating at the main wreckage. The first several hundred feet of the debris path contained trees that had their respective treetops sheared off. The tops were sheared off at approximately the same height, about 60 feet above the ground.

All major components of the airplane were accounted for at the scene. From the initial impact point, a section of wingtip was located about 50 feet along the debris path. Sections of both ailerons, and an outboard portion of the left wing were located about 80 feet along the debris path. An oil-to-fuel heater was located further, and it contained a liquid consistent with Jet A aviation fuel. An engine nacelle was then located about 200 feet along the debris path. Although the majority of debris was observed along the path that terminated at the main wreckage, both engines were located about 200 feet beyond the main wreckage.

Four propeller blades were located along the debris path. Two blades remained attached to a partial hub, one blade was found separated, and the fourth blade remained attached to a different partial hub. Four additional propeller blades were located in the vicinity of the main wreckage. The propeller blades exhibited leading edge gouging, chordwise scratches, and s-bending. The left engine was resting on top of a fallen tree, and contained residual oil. The first stage reduction gear box and exhaust duct had separated from the left engine. The first stage power turbine was exposed. The turbine vanes exhibited leading edge gouging and circumferential scoring along the shroud. The accessory gearbox had separated from the engine, and the gears could not be rotated, which was consistent with impact damage. The left engine gas generator was compressed torsionally.

The right engine was found in the vicinity of the left engine. The first stage compressor turbine was exposed. The vanes exhibited leading edge gouging. The right engine inlet case and accessory gearbox had separated, and were located near the main wreckage. The gas generator and exhaust duct exhibited torsional creasing. The first stage compressor turbine was rotated by hand, with some resistance, which was consistent with impact damage.

The main wreckage consisted of a section of right wing, the cockpit area, and the empennage. The left main landing gear was located along the debris path, and the right main landing was recovered near the engines. The nose gear was not recovered. The radar altimeter was the only readable instrument recovered from the cockpit. The caution panel lights and cabin pressu

Aircraft

Registration
N200BE
Reported as
Beech 200
Category
Airplane
Serial number
BB-832
Airframe hours
9,449
Engines
Pratt & Whitney PT6A-41, 850 horsepower, turbo propPratt & Whitney PT6A-41, 850 horsepower, turbo prop
Damage
Destroyed
Fire
On-Ground
Flight
Positioning · Part 91
Operator
Rader Aviation Inc
Registered owner
Land Use Corporation
Airworthiness certificate
Standard, Normal
Last inspection
AAIP · June 9, 2004 · 5 hours before
Departed
SXL · Summersville, WV
Destination
LWB · Lewsiburg, WV
Flight plan
IFR
Airport
LWB · Greenbriar Valley Airport

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
67
Injuries
Fatal
Certificate
Airline transport
Airplane ratings
Single-engine land, Multi-engine land, Single-engine sea
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--w/ waivers/lim
Last flight review
May 17, 2004
Seat
Left
Toxicology
Performed
Flight hours
10,400 total · 1,500 in this make and model · 10,375 as pilot in command · 80 in the last 90 days · 35 in the last 30 days · 1 in the last 24 hours
Role
Co-pilot
Age
56
Injuries
Fatal
Certificate
Commercial
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--w/ waivers/lim
Last flight review
April 5, 2004
Seat
Right
Toxicology
Performed
Flight hours
2,910 total · 400 in this make and model · 1,900 as pilot in command · 60 in the last 90 days · 20 in the last 30 days · 1 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
Calm
Visibility
7 statute miles
Lowest ceiling
1,800 ft overcast
Temperature
61 °F, dew point 61 °F
Altimeter
30.22 inHg
Observed at
LWB, 16 nm away

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.